April 28, 2014

Costly Kidney Stone Treatment Complications Are Quite Common

While surgical procedures to treat kidney stones are fairly common these days, about one-in-seven results in complications that require additional, potentially expensive, care, according to a new study in the journal Surgery.

The study revealed that the average cost of these complications, in the form of emergency care, is about $30,000.

“Our findings provide a good starting point to understand why these complications are happening and how they can be prevented, because the costs to patients who suffer complications and to the health care system are substantial,” said study author Dr. Charles D. Scales, assistant professor of surgery at Duke University, in a recent statement.

Common therapies to treat kidney stones include using shock waves from outside the body to blast a stone, inserting a tube into the urethra and extracting any stones through a small incision made in the lower back. The total annual cost of these procedures in the United States is estimated at around $10 billion, according to the study team.

In the study, scientists from Duke, the RAND Corporation and UCLA reviewed the end results of greater than 93,000 privately-insured patients who experienced treatment for kidney stones. To determine if follow-up care was necessary after the initial procedure, the scientists looked at emergency room trips or hospital visitations within 30 days of the initial kidney stone treatment, a lengthier window than had been studied prior.

The study team found that patients who had their kidney stone operation at hospitals who regularly report high volumes of the procedure were significantly less likely to have difficulties.

When difficulties took place, they were least frequent after shock wave treatment, afflicting 12 percent of patients. Those who received ureteroscopy therapy, the next most frequent procedure, had even more future related visits, with 15 percent of patients. However, shock wave therapy did have the greater costs linked with the emergency appointments, at over $32,000. Charges for difficulties of incision-based surgery were highest, averaging more than $47,000 when a complication-related visit took place.

Scales said additional study is necessary to discover why these procedures resulted in distinct complication levels and costs, but mentioned patients may not be prepared for difficulties as a result of minimally invasive procedures.

“From the patient perspective, an unplanned emergency department visit or hospital admission after a low-risk ambulatory procedure is a significant event,” Scales said. “Kidney stones are excruciatingly painful and primarily affect people who are of working age. These patients face not only the cost of treatment, but also the financial difficulties from time off work due to pain and treatment.”

With the costs related to medical procedures currently under more scrutiny than ever, these findings are particularly relevant to public policy decisions, Scales said.

“Reducing unplanned emergency visits and hospitalizations associated with kidney stone treatments could result in significant cost savings if the causes can be identified and addressed,” Scales said.

He added that his future research will probably include determining why problems occur and how they can be prevented.